You Can Lead Health Workers to Water...

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Annie Feighery

By Joe Levine

Access to clean water and sanitation has been credited with doing more to improve health and life expectancy than any other public health advance of the modern era. But the job is far from completed. Water-borne disease is the world’s second leading cause of childhood mortality. Drinking contaminated water is a main cause of diarrheal disease, which results in 1.5 million deaths each year in children under the age of 5. Diarrheal disease also contributes to malnutrition and stunting, because it decreases the intestine’s uptake of nutrients.

One longstanding major barrier to preventing water-borne disease has been that water quality testing can only be conducted periodically by scientists who have access to a temperature-controlled microbiology lab in which to analyze the results. But now that is changing thanks to mWater, a non-profit tech startup created by Annie Feighery, a TC student who is completing her doctorate in Health Education this fall, and her two co-founders: husband John Feighery, a Columbia engineering graduate who spent more than a decade monitoring water quality for NASA’s international space station, and Clayton Grassick, a software developer in Montreal.

The team has created a mobile phone app that lets users instantly test and analyze water quality from local sources and share the information on a global, open-source water monitoring database.

The app, which can be downloaded for free from the Android Store, requires no scientific expertise and can be employed under room-temperature conditions to determine whether drinking and bathing water meet different standards set by the World Health Organization and the U.S. Environmental Protection Agency. The app uses cameras in mobile phones to automatically detect colonies of coliform and E. coli bacteria that are grown on test plates from water samples.

So far the app has been used in Tanzania, Ethiopia and Rwanda. The company also is working with Riverkeeper, a clean water advocacy nonprofit in New York, and with other water groups in the Hudson Valley.

“This marks the first time that health workers are being involved in testing water quality,” says Annie Feighery. “We train them in the use of the app and stay only long enough to ensure that they can do it. Our goal is to build local capacity rather than establish a lasting presence. We return later to re-train and assess whether use of the app has made an impact.”

Use of the app is most widespread in Tanzania, where the company was recently the recipient of a $100,000 investment by the USAID’s Development Innovation Ventures initiative. In preliminary work in Mwanza, a city of 2 million people located on the shores of Lake Victoria that is among Africa’s fast growing urban centers, testing of more than 100 water sources found fecal contamination in 90 percent of shallow dug wells and springs – many of which were located only a short distance from safer water kiosks.

“One of our really interesting baseline findings is that families typically rely on at least three different water sources,” she says. “That runs counter to the widespread assumption that each family relies on a single source.” That finding – which Feighery says is likely to be true in developing nations around the globe – indicates that having up-front information about water safety could guide people in making safer choices.Feighery credits mWater’s Montreal-based partner with overcoming some difficult technological hurdles in creating the app. But she points to the proliferation of cell phones in general, and the advent of mobile banking in particular, as the broader advances that have paved the way for the app’s creation and enabled it to have a widespread impact.

“In Tanzania, more people have access to a mobile phone than to a safe water source,” Feighery says. “And now that people can use their phones for banking, the market penetration is over 60 percent. That allows the mobile phone to provide infrastructure you can build a health program on.”

As part of its emphasis on building local capacity, mWater buys its cell phones locally in each region in which it works and also negotiates with local phone companies to provide free minutes to health workers.

Feighery plans to return to Mwanza in December to evaluate rates of water-borne disease in the districts where the mWater app has been in use. Meanwhile, the company has just created two new apps that will help workers run health surveys on a smart phone instead of using paper. One, called Broad Street, is directed at health care providers to help them report cases of diarrheal disease.

“What we’re really trying to do is create a platform for multi-sector collaboration that brings together environmental health workers, health care providers – doctors, nurses and midwives – and water managers, all with the goal of reducing diarrheal disease,” she says.

At TC, Feighery wrote her dissertation on the use of mobile phones for disaster response, with post-earthquake efforts in Haiti as a case study. John Allegrante, Professor of Health Education and Vice President for International Affairs, was her adviser.

“I chose TC rather than a conventional public health school because I knew coming in that I wanted to do innovative, interdisciplinary work,” says Feighery, who describes herself as having “grown up” in the nonprofit for teen mothers that her mother ran back home in New Mexico. “This is preventive health, not health epidemiology. Other programs weren’t comfortable with that, but TC was absolutely amenable to it. And doing this kind of work -- looking at behavioral approaches to building health and well-being as opposed to simply tracking disease -- has helped me to become a highly valued as an expert in my field.”